Thread: My Thought on the first part
Post: My Thought on the first part
Author: STUDENT Amy

Posted Date: March 9, 2007 12:45 PM
Status: Published

Refusal of treatment Mrs X

Anyone after their 'legal age' is deemed competent and can refuse treatment as well as consent to it, as patients want to control what happens to them ( Gillick Competence).

A adult who is sane, can refuse even life saving treatment as a competent decision once made mmust be respected.

Mrs X has made a 'self determined' choice.  I think the doctor should respect Mrs X choice even though she has a young daughter I think she has to have thought of her before she made her decision. 

Mrs X's doctor would have to be satisfied that that the refusal is well informed in my opinion.

Student A

Thread: My Thought on the first part
Post: RE:My Thought on the first part
Author: STUDENT Brenda

Posted Date: March 11, 2007 7:03 PM
Status: Published

I would agree with you here that the patient as a competent patient should have her wishes repsected. She has made this decision after being counselled and has still decided she does not want the treatment.

Although I do think that the fact she has a daughter does make this a difficult situation to evaluate, in the end it is still the patient's decision and the clinician cannot treat her unless her consent is given.

Student B

Thread: My Thought on the first part
Post: RE:My Thought on the first part
Author: STUDENT Ciaran

Posted Date: March 12, 2007 1:12 PM
Status: Published

I absolutely agree, If Mrs X fully understands that failure to receive this treatment will result in her death, and that she has had appropriate explanations of the treatment available, counseling and help in relation to her concerns, or fears of the treatment, and reasonable time to consider all the information and her decision, then I believe that it is her decision that is important under no circumstances should she be made to take the treatment, her choice is to be respected and accepted.

Student C

Thread: My Thought on the first part
Post: RE:My Thought on the first part
Author: STUDENT Dave

Posted Date: March 13, 2007 12:08 AM
Status: Published

I agree -- although my instincts would tell me to treat the lady, she is a competent adult, and all that can be offered is advice and counselling in the hope that she would change her mind.  Since this has already been done, and she has been informed of all the facts, there is no way that the clinician can treat her, no matter what his morals say.  In this scenario, I think the law wins over ethics!

Thread: My Thought on the first part
Post: RE:My Thought on the first part
Author: STUDENT Eric

Posted Date: March 13, 2007 11:41 AM
Status: Published

gillick compentence is the key here..i persons rights to make there own decisions should be paramount.

Thread: link
Post: link
Author: STUDENT Brenda

Posted Date: March 11, 2007 6:57 PM
Status: Published

This link was really useful as it discusses both the ethical and legal issues involved with the consent of both competent and incompetent patients.

http://www.ethox.org.uk/Ethics/econsent.htm

Hope it helps

Student B

Thread: part 2
Post: part 2
Author: STUDENT Brenda

Posted Date: March 11, 2007 7:13 PM
Status: Published

In evaluating whether this patient should receive treatment the 'best interests' approach would have to be applied.

I understand that she has a learning disability, but does this mean she is incompetent? Does her disability mean she cannot comprehend what would be involved if she did have the operation and what the outcome would be if she did not?

I think a weighing up of the effects either way should be done so that it could be determined what would be in her best interest, and if in fact she is competent to have an input in the decision.

I just don't think it is as clear cut as: the patient has a learning disability so she is incompetent.

Student B

Thread: part 2
Post: RE:part 2
Author: STUDENT Eric

Posted Date: March 12, 2007 12:44 PM
Status: Published

i would agree..learning disablility may not result in being not able minded to make these decisions. if infact this does effect her decision making then i think the treatment should be given. the daughter in my opinion does not come into it because automony should be respected,if however shes not able minded in making decisions then surgoens should proceed with treatment.

Thread: part 2
Post: RE:RE:part 2
Author: STUDENT Eric

Posted Date: March 12, 2007 12:47 PM
Status: Published

sorry got mixed up..the duaghter aint part of the second part lol. so ignore that part.

Thread: part 2
Post: RE:RE:part 2
Author: STUDENT Ciaran

Posted Date: March 12, 2007 1:28 PM
Status: Published

I agree, in that a learning difficulty does not mean someone does not have the capacity to consent, nor does being in a care home.  In the case of Re C [1994] 1 WLR 290 the patient was detained in a mental  hospital yet he was still considered to have the capacity to refuse treatment, based on the three point test which was set in this case. the link below will take you too it, its from the earlier link provide (which was really good, thanks)

http://www.ethox.org.uk/Ethics/econsent.htm#capacity

However I believe that as long as the patient understands the consequences of not having the treatment and they are will to accept these, then their decision should stand, I feel very strongly against anyone having to go through any treatment that they dont wish to have.  In this case if Mrs Y is considered to not have capacity to make a reasonable choice, I think that as long as she understands that she could die without the treatment and of course understands what death is then that should be enough, It should not matter whether she understands the treatment or its benefits, as long as she understands the worst possible consequences, then in my opinion that is enough.

Without knowing too much about Mrs Y case my instinct is to say she should not receive treatment as its against her wishes.

Thread: part 2
Post: RE:part 2
Author: STUDENT Dave

Posted Date: March 13, 2007 12:10 AM
Status: Published

Yes, I think it's neccessary to have all the facts and details about her disability before a judgement can be made on her competency, although my first reaction was that she was not competent to make the decicision.

Thread: part 2
Post: RE:RE:part 2
Author: STUDENT Amy

Posted Date: March 13, 2007 2:12 PM
Status: Published

I agree here!! we need more info on her disability..................

I dont agree that she should be treated just because her disability as it only states that she has a 'learing disability' this could mean that she may not be able to read or write, then she should have some with her that will be able to read and/or sign on her behalf then again a simple X could be used as her 'sign'. 

Student A

Thread: My Thoughts on Q1
Post: My Thoughts on Q1
Author: STUDENT Eric

Posted Date: March 12, 2007 12:53 PM
Status: Published

I think that automony is the key factor here. if you are a able minded individual of the age where you are considered to be able to make decisions then you have a right to refuse this treatment or any sort of treatment for that matter.

the fact no other alternative methods of treatment is available and she knows this and all the necessary work has been put in to try and convince her then the medical staff have done as much as they can in my opinion. The daughter although it sounds harsh wont come into it,automony reigns here i feel. thanks

Thread: My Thoughts on Q1
Post: RE:My Thoughts on Q1
Author: STUDENT Ciaran

Posted Date: March 12, 2007 1:31 PM
Status: Published

I totally agree the only consideration here for me is autonomy. She knows the treatment available, she knows the risk and understands them.  It is her decision that is to be respected by her daughter and doctor alike.

Thread: Thoughts on 2
Post: Thoughts on 2
Author: STUDENT Eric

Posted Date: March 12, 2007 12:59 PM
Status: Published

hi, i think the question is obviously weather or not the patient here is compentent and can make decisions with a clear head. this has been made in other points in other threads but i think this was correct. just because learning problems are an issue..does this make the person incompentent?..

this is a matter that the relevant bodies working with the patient have to make, the wishes of the neice assuming its her next of kin should only be considered in my opinion when compentence is evaluated one way or the other. thanks

Thread: Ethical Question!
Post: Ethical Question!
Author: STUDENT Eric

Posted Date: March 13, 2007 1:19 PM
Status: Published

Just a thought but if we allow people to make there own choices about recieving treatment thats life saving then this is surely in some cases this results in euthanasia/self termination?

might seem extreme but surely in some circumstances where the refusal of treatment will result in death this is in some circumstances one of the above?

just a thought.thanks.

Thread: Ethical Question!
Post: RE:Ethical Question!
Author: STUDENT Dave

Posted Date: March 13, 2007 10:00 PM
Status: Published

I think this is a really valid point...although I'm not too sure if it would actually be classed as euthanasia...obviously it would depend on the circumstances of the case, but I think it's something interesting to think about.

Thread: Consent
Post: Consent
Author: STUDENT Fiona

Posted Date: March 13, 2007 4:20 PM
Status: Published

Hi,

With regards to scenario 1, I do not think the clinician has the right to treat Mrs X if she has specifically asked not to be treated.  She would be deemed competent to make her own decisions which I think should be respected. If mrs X knows the consequences of not having treatment then that is her right to refuse.  In this case I do not think the clinician can treat her.

In scenario 2 I think the clinician should choose to treat Mrs Y.  Mrs Y has a menatl disability and this could affect her understanding of the situtaion.  I think that since this is a serious situation, the clinicain cannot risk not treating her as she may not understand the consequences of her objections, she may not believe the situation to be as serious as it is.  It would be in the best interests of Mrs Y.